Your best bet is to get your E2 under control BEFORE you get gyno. From what I’ve read you CAN have gyno with or without pain or itchiness, though the worse it gets the higher the chance of having pain and itchiness. I read a few posts from guys who do steroids who say that they get puffy nipples while on the juice and it goes away when they stop. They’re hyper-dosing T though, so they’re more likely to have side effects than your average TRT user and it’s likely they weren’t dosing the estrogen blocker correctly. (In fact one guy I read didn’t even know what estrogen blockers were, so it was easy to figure out what he was doing wrong.) Early-stage gyno is reversible by getting your estrogen in check, so even if you do have it, it’s likely no severe and it should go away without the need for surgery. I wouldn’t worry too much, just get your E2 checked.
I had low-ish E2 before starting TRT as well. I started getting hot-flashes, got my levels checked, and started anastrozole. The optimal E2 level varies from person to person, and if you ask 5 guys where they keep their E2 levels, you may get 5 different answers. The standard tends to be low-mid 20s to low 30s. Some guys do great over (or under) that range, but it’s a good starting point. Mine stays around 23. It’s best to go roughly by symptoms: If you start getting joint pain your E2 is too low - tender tits, hot flashes, etc., too high. ED can happen with high or low E2. Both hCG and Testosterone will raise E2 levels, so it’s good to keep tabs on it.
Since you seem to be happy with your current dose of hCG I wouldn’t change it.
To expand on why hCG alone won’t work: If you have Primary Hypogonadism then your testicles don’t produce enough testosterone. It’s not a matter of them not getting the right signals from the brain, or other things going wrong (thyroid, pituitary, etc.), but just that your testicles refuse to do their job. HCG mimics chemicals your brain produces that tell the testicles to produce testosterone. If they don’t produce decent levels in the first place, then adding a chemical to tell them to produce testosterone won’t make them produce any more than they do “naturally”. This is why you need to take synthetic T. You add the hCG to prevent the testicles from shutting down and hurting (or even receding!).
I don’t think taking some time off from TRT will help the hair situation much. As the Emperor said “It is your destiny”. I know it blows, but, as with everything in genetics, you’re stuck with what you got. Propecia and Avodart are designed to prevent the balding process, and if that isn’t working then you are either looking at: A) Shaving your head; or B) Hair replacement surgery. My best friend went through option B, so if you need some info let me know. Even after the surgery he still has to take propecia and use rogaine, but he doesn’t have to keep his hair long to hide the thinning any more.
I’d personally rather shave my head than go through another surgery, but I was a swimmer for years so I guess I’m used to the idea of taking a bic to the head.
Let me know how things go, or if there’s anything else on which you need clarification.